FORM 1023-EZ for NWA CHARITY KICKBALL

Field Data
EIN 81-2472903
Case Number EO-2016342-000218
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NWA CHARITY KICKBALL
Organization’s Mailing Address 2406 SOUTH 16TH ST
City ROGERS
State AR
ZIP 72758
Accounting period End 5
Primary contact name MELLISSA SHRIVER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MELLISSA SHRIVER
ACTIVITIES DIRECTOR
2406 S 16TH ST
ROGERS AR 72758

Officer/Director/Trustee Two

BETHANY STEWART
COORDINATING DIRECTOR
1102 N PLEASANT ST
SPRINGDALE AR 72764

Officer/Director/Trustee Three

COREY STEWART
TRUSTEE
1102 N PLEASANT ST
SPRINGDALE AR 72764

Officer/Director/Trustee Four

MARANDY SMITH
TRUSTEE
1503 GREENLAWN DR
SPRINGDALE AR 72764

Officer/Director/Trustee Five

CHRIS SMITH
TRUSTEE
1503 GREENLAWN DR
SPRINGDALE AR 72764

Organization’s website
Organization’s email NWACHARITYKICKBALL@YAHOO.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/5/2016
Organization Incorporation State AR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N12 - Fund Raising and/or Fund Distribution
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds Yes
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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